After effects of shingles in the elderly - Chiang Mai doctor

[Chicog]

I've got an old friend (70+) who last year contracted shingles which it seems got into his optic nerve.

While the shingles themselves subsided, he's been left for more than a year now with bouts of headaches, an eye that periodically waters and stings, and with it comes out in a rash in the surrounding skin area.

He's seeing an Indian doctor here in the sandpit, but all the bloke does is prescribe eye drops without actually telling him what they're for, and they don't seem to do anything even though he's been taking them for a year or so.

Can anybody recommend (from personal experience) a good ophthalmologist in Chiang Mai (preferably) or at a push Bangkok who might be able to offer a considered second opinion?

Thanks.

[Langsuan Man]

You friend needs a good neurologist, he is suffering from Postherpetic neuralgia which is a nerve pain due to damage caused by the varicella zoster virus

Most neurologist will prescribe Anticonvulsants such as Neurontin, since it is dealing with nerve tissue I don't think an ophthalmologist is going to do much for him

see this for more information and treatment options:

http://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/basics/definition/con-20023743

[Sheryl]

No, I think this is zoster opthalmicus which is indeed an eye condition, a known complication of shingles.

there is an Ocular Infectious Disease Clinic at Maharaj Nakorn Chiang Mai Hospital. Try thta. Or if he prefers to go through Sripat, request on of these opthalmoogists:

Dr. Somsanguan Ausayakhun

Dr. Natedao Kongyai

Dr. Kessara Pathanapitoon

Dr. Kessara is also available at CM Ram Hospital

[Chicog]

Thank you kindly, I'll pass it on.

[chubby]

re: what sheryl said it seems, fwiw, i have had a least 1 old patient, who became paralyzed 2' zoster, therefore get your vaccine, if you are over 55 ....

PS : this about the acute phase, so, it may be a little late, to limit morbidity, though, probably worth seeing if long term eye drops are advisable to prevent glaucoma-like blindness?

• Treatment
  • Oral antivirals (eg, acyclovir
    
    
    , famciclovir
    
    
    , valacyclovir
    
    
    )
  • Sometimes topical corticosteroids

  Early treatment with acyclovir
  
  
  800 mg po 5 times/day or famciclovir
  
  
  500 mg or valacyclovir
  
  
  1 g po tid for 7 days reduces ocular complications. Patients with uveitis or keratitis require topical corticosteroids (eg, prednisolone
  
  
  
  acetate 1% instilled q 1 h for uveitis or qid for keratitis initially, lengthening the interval as symptoms lessen). The pupil should be dilated with atropine
  
  
  1% orscopolamine
  
  
  0.25% 1 drop tid. Intraocular pressure must be monitored and treated if it rises significantly above normal values.

  Use of a brief course of high-dose oral corticosteroids to prevent postherpetic neuralgia in patients > 60 yr who are in good general health remains controversial.

  Key Points
  • The eye is affected in about half of cases of V1 varicella-zoster virus reactivation.
  • Keratitis and/or uveitis can be severe and cause morbidity.
  • Appearance of the typical herpes zoster rash is usually diagnostic.
  • Treatment is with oral antivirals and usually topical corticosteroids and pupillary dilation.
  ical corticosteroids and pupillary dilation.

Edited April 3, 2015 by chubby